Heterogeneity in cancer guidelines: should we eradicate or tolerate?

Background: Heterogeneity in aspects of development, structure and context of oncology guidelines was not evaluated. We analysed and critically examined its implications. Materials and methods: Nine cancer clinical practice guidelines were selected on the basis of popularity among oncologists. The relevant Web sites and publications on three tumours were examined and characteristics grouped in the data domains: producing organisation, methodology, guideline structure and content, implementation and evaluation and scientific agreement. Results: ASCO, ESMO, NICE, SIGN, START, NHMRC, NCI, NCCN and CCO guidelines were examined. Development was initiated by stakeholders or authorised bodies, run by task forces with varying degrees of multidisciplinarity, with rare endorsement of external guidelines. Recommendation formulation was on the basis of evidence, shaped via interactive processes of expert review and public consultation-based modifications. Guidelines varied in comprehensiveness per tumour type, number, size, format, grading of evidence, update and legal issues. Orientation for clinic use or as reference document, end-users and binding or elective nature also varied. Standard dissemination strategies were used, though evaluation of adoption and of impact on health outcomes was implemented with considerable heterogeneity. Conclusions: Heterogeneity in development, structure, user and end points of guidelines is evident, though necessary in order to meet divergent demands. Crucial for their effectiveness are adherence to methodological standards, a clear definition of what the guideline intends to do for whom and a systematic evaluation of their impact on health car

A comparison of the socio-psycho-educational and personality characteristics of learning disabled and dyslexic children with normal controls

Introduction: LD-dyslexic children experience more social isolation, social exclusion, loneliness less access to social goods -i. e. in education, employment, welfare, etc. (Bryan & Bryan, 1990). Students with learning disorders view themselves as more lonely and report lower levels of the sense of coherence than the average achieving pupils. (Wiener, 1998). Their reading and other learning problems are likely to continue into adulthood, with destructive effects on their feelings of self worth, personal relationships and job opportunities. Last but not least, learning disabilities have been associated with juvenile delinquency. A variety of theories concerning this purported causal relationship have been proposed. Although the assumption that learning disability plays a primary role in a delinquent outcome, remains open to question. Aim: This study examined whether: 1) There is a significant correlation between the socio-psycho-educational- environmental problems and learning disabilities. 2) They can be differentiated from their normal controls on the basis of their psycho-socio-educational profile. Material: The parents of normal controls participating in the study were individually given a questionnaire to complete about their children's reactions and social behaviour. The dyslexic children's parents had already filled in an extended questionnaire that was especially developed by Professor G. Pavlidis for students with Learning Difficulties and Dyslexia. Subiects: Two hundred and twenty seven (227 - 122 boys and 104 girls) children and their parents, took part in this research. The children attended grades 3 through 6. The sample consisted of a hundred and thirty six (136) normal controls -57 boys and 78 girls, and ninety one (91) dyslexics and learning disabled children -65 boys and 26 girls-drawn from the Dyslexia and I. Q. Center, where they were diagnosed by Prof. Pavlidis. The controls were indentified according to their parents answers who had filled in the Pavlidis Questionnaire that was mentioned above. (LD children had similar characteristics as the dyslexics, however they did not fulfil all the criteria to be classified as dyslexics. For instance, for a child to be diagnosed as dyslexic it is necessary to fall significantly behind in reading. Our LD child had similar problems with dyslexic and ADHD in their written expression etc but their reading was not as bad). The subjects' selection as well as their testing took place according to standard ethics and after the necessary permissions were received and the appropriate informed consents were filled out. Results: The LD-dyslexic children's psycho-socio-educational characteristics were found to be significantly different worse than those of the normal controls of the same age. In fact, the two groups different so much that on the basis of their psycho-socio-educational profile the Discriminant Analysis (DA) successfully classified the two groups with accuracy of 94,6%. The LD-dyslexic group was correctly identified with 97,6% while the normal controls were classified with 93,7% accuracy. Conclusions: The very high discrimination accuracy between the two groups raises the possibility to use the Pavlidis Questionnaire as a quick, easy to administer, inexpensive and highly accurate screening tool for children with suspected LD-dyslexia. This potential will be of particular importance to countries like Greece, where only few and very limited possibilities exist within the educational system for the diagnosis of the LD-dyslexic children. However, one has to be cautions to the strong possibility not to be able to discriminate between specific LD-dyslexics and children with general learning retardation, whichQ may have very different etiology, e.g. due to low IQ.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A comparison of the socio-psycho-educational and personality characteristics of learning disabled and dyslexic children with normal controls

Introduction: LD-dyslexic children experience more social isolation, social exclusion, loneliness less access to social goods -i. e. in education, employment, welfare, etc. (Bryan & Bryan, 1990). Students with learning disorders view themselves as more lonely and report lower levels of the sense of coherence than the average achieving pupils. (Wiener, 1998). Their reading and other learning problems are likely to continue into adulthood, with destructive effects on their feelings of self worth, personal relationships and job opportunities. Last but not least, learning disabilities have been associated with juvenile delinquency. A variety of theories concerning this purported causal relationship have been proposed. Although the assumption that learning disability plays a primary role in a delinquent outcome, remains open to question. Aim: This study examined whether: 1) There is a significant correlation between the socio-psycho-educational- environmental problems and learning disabilities. 2) They can be differentiated from their normal controls on the basis of their psycho-socio-educational profile. Material: The parents of normal controls participating in the study were individually given a questionnaire to complete about their children's reactions and social behaviour. The dyslexic children's parents had already filled in an extended questionnaire that was especially developed by Professor G. Pavlidis for students with Learning Difficulties and Dyslexia. Subiects: Two hundred and twenty seven (227 - 122 boys and 104 girls) children and their parents, took part in this research. The children attended grades 3 through 6. The sample consisted of a hundred and thirty six (136) normal controls -57 boys and 78 girls, and ninety one (91) dyslexics and learning disabled children -65 boys and 26 girls-drawn from the Dyslexia and I. Q. Center, where they were diagnosed by Prof. Pavlidis. The controls were indentified according to their parents answers who had filled in the Pavlidis Questionnaire that was mentioned above. (LD children had similar characteristics as the dyslexics, however they did not fulfil all the criteria to be classified as dyslexics. For instance, for a child to be diagnosed as dyslexic it is necessary to fall significantly behind in reading. Our LD child had similar problems with dyslexic and ADHD in their written expression etc but their reading was not as bad). The subjects' selection as well as their testing took place according to standard ethics and after the necessary permissions were received and the appropriate informed consents were filled out. Results: The LD-dyslexic children's psycho-socio-educational characteristics were found to be significantly different worse than those of the normal controls of the same age. In fact, the two groups different so much that on the basis of their psycho-socio-educational profile the Discriminant Analysis (DA) successfully classified the two groups with accuracy of 94,6%. The LD-dyslexic group was correctly identified with 97,6% while the normal controls were classified with 93,7% accuracy. Conclusions: The very high discrimination accuracy between the two groups raises the possibility to use the Pavlidis Questionnaire as a quick, easy to administer, inexpensive and highly accurate screening tool for children with suspected LD-dyslexia. This potential will be of particular importance to countries like Greece, where only few and very limited possibilities exist within the educational system for the diagnosis of the LD-dyslexic children. However, one has to be cautions to the strong possibility not to be able to discriminate between specific LD-dyslexics and children with general learning retardation, whichQ may have very different etiology, e.g. due to low IQ.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Hierarchically coupled ultradian oscillators generating robust circadian rhythms

Ensembles of mutually coupled ultradian cellular oscillators have been proposed by a number of authors to explain the generation of circadian rhythms in mammals. Most mathematical models using many coupled oscillators predict that the output period should vary as the square root of the number of participating units, thus being inconsistent with the well-established experimental result that ablation of substantial parts of the suprachiasmatic nuclei (SCN), the main circadian pacemaker in mammals, does not eliminate the overt circadian functions, which show no changes in the phases or periods of the rhythms. From these observations, we have developed a theoretical model that exhibits the robustness of the circadian clock to changes in the number of cells in the SCN, and that is readily adaptable to include the successful features of other known models of circadian regulation, such as the phase response curves and light resetting of the phase

The cultural adaptation of the everyday problems test—Greek version: an instrument to examine everyday functioning

Assessing cognitive decline and everyday functioning (EvF) in older age is valuable in detecting age-related neurological disorders. In Greece, there is a lack of sensitive instruments that capture fluctuations in EvF among older persons who are cognitively healthy or have subtle cognitive impairments. The EPT 28-items test, a widely used paper-and-pencil EvF measure, was translated in Greek and adapted to the Greek culture in this study. A multi-step methodology using a sample of 139 older Greek persons was employed. The results indicate that the Greek version of the EPT 28-items (i.e., the EPT-G) was well adapted, representing everyday tasks in Greece within a good range of task difficulty. The psychometric properties of the EPT-G replicate those of the original instrument, capturing EvF fluctuations among older persons with mild cognitive impairments. It was concluded that the EPT-G is a useful measure of EvF among Greek older persons